Formative research methods to understand patient and provider responses to heart attack symptoms

Formative research is often required for program planning, and for reducing uncertainty about generalizability of program effects. This article describes and justifies methods of formative research conducted for the REACT study (Rapid Early Action for Coronary Treatment), a multi-center collaborative randomized community trial aimed at reducing patient delay in seeking care for acute myocardial infarction (AMI). Formative research cast light on patient and community members’ decision-making process in seeking help for AMI, as well as barriers and facilitators of this process. Investigators at all five REACT Field Centers participated in the formative research. The process consisted of: (1) developing a common theoretical framework for the study intervention; (2) conducting a literature review and qualitative research to identify and address gaps in knowledge; and (3) developing a common protocol for the REACT study that accommodated the diversity of the target communities in terms of services, resources, history, and ethnicity. Analysis employed triangulation, defined as an explicit search for heterogeneous data sources to reduce uncertainty about forces at work and opportunities for intervention across settings and populations. Because the collection and interpretation of data went in stages, staff of several REACT Field Centers had independent input to the overall synthesis, then shared and revised the results. Advantages and limitations of this approach are discussed.     

Economic Impact of Accelerated Cleanup on Regions Surrounding the U.S. DOE's Major Nuclear Weapons Sites

The regional economic impacts of the U.S. Department of Energy's accelerated environmental cleanup plan are estimated for the major nuclear weapons sites in Colorado, Idaho, New Mexico, South Carolina, Tennessee, and Washington. The analysis shows that the impact falls heavily on the three relatively rural regions around the Savannah River (SC), Hanford (WA), and Idaho National Engineering and Environmental Laboratory (ID) sites. A less aggressive phase-down of environmental management funds and separate funds to invest in education and infrastructure in the regions helps buffer the impacts on jobs, personal income, and gross regional product. Policy options open to the federal and state and local governments are discussed.     

An Assertiveness Training Program for Indecisive Students Attending an Italian University

Indecisive students often present with social skills problems, which may make academic and vocational decision‐making tasks difficult and complex for them. Moreover, choices regarding one's future require the ability to gather information, to search for help and support, to stave off intrusiveness and pressures, and to communicate one's decisions. Social competencies, particularly, play a significant role in vocational guidance activities. This article presents a training program devised to augment assertive competencies in indecisive students choosing a university course of study. Intended aims and the analyses to assess the efficacy of the intervention through self‐evaluation and role‐play assessment are described.     

Fertility Changes Among Immigrants: Generations,Neighborhoods, and Personal Characteristics*

Objective. To understand how adaptation/assimilation, disruption, and diffusion interact to produce changes in fertility levels among successive generations of Mexicans and Central Americans in the United States. Method. Using restricted access data that link individual data (CPS) to neighborhood data (census tracts), we examine the role of generation, personal characteristics, and neighborhood characteristics in determining children ever born (CEB). Results. There are significant differences in fertility across generations and, to a lesser extent, between women who live in ethnic enclaves and those who do not. Once personal characteristics are considered, the independent effect of generation on fertility is nearly eliminated. Personal characteristics dominate neighborhood characteristics in their ability to predict fertility. The most consistent predictor of CEB at the neighborhood level is the percentage of Hispanic adults. Conclusions. Personal characteristics dominate fertility change across generation, and were it not for increases in educational attainment, fertility might be higher in successive generations rather than lower or unchanged.     

THE HEALTHY LIVING CENTER

Through collaboration with the Toy Industry Foundation, Homes for the Homeless launched the Healthy Living Center project in May 2003. The Healthy Living Center attempts to promote positive youth development in a recreational setting that incorporates informal education. Three primary goals guide the creation and implementation of Healthy Living Center components; first, to expose children to creative, social play, giving them a framework for positive socialization that can often be elusive for homeless children as a result of frequent transitions and instability; next, to give children the opportunity to develop their own talents, skills, and creativity, thus enhancing the child's cognitive skills, as well as his or her self‐concept and sense of self‐worth; and finally, to provide a positive, youth‐centered framework for a child's self‐development. This framework gives children vital tools for long‐term success, giving them practice in forming and maintaining positive social relationships and helping them to fully discover and take advantage of their own personal strengths and potential.     

Experiencing Hate Speech: Perceptions and Responses to Anti-Semitism and Antigay Speech

This study examines how people experience hate speech. Specifically, it assesses people's perceptions regarding both the antecedents and outcomes of such expression targeted at Jews and homosexuals. One hundred twenty university students read (and in some cases also supplied) real-life epithets aimed at their social identity and then provided an assessment of their (a) perceived short- and long-term consequences, (b) understanding of the motive behind the message, (c) response to the sender, and (d) response to the message in terms of soliciting social support. A content analysis of the accounts produced the following patterns: (a) short- and long-term consequences mirrored a three-stage sequence found within other traumatic experiences; (b) respondents described motives as enduring, not situational, states; (c) the most common response strategies were passive; and (d) participants often sought support. The discussion focuses on implications for interventions that may mitigate negative consequences of hate speech.     

Sports in School: Source of Amity or Antipathy?

Objectives . Previous research looks at the impact of school sports on participants' delinquency, but not at the impact on delinquency in schools; further, it does not control for school size or for unobserved school-level variables. This research fills that gap. It uses social capital theory to frame the impact of sports programs on both participants and nonparticipants. Social capital theory predicts that group cohesion will increase cooperative, pro-social behavior among those in the group; however, it can also increase uncooperative, antisocial behavior among those not in the group—particularly when in-group membership is seen as desirable. Social capital theory also predicts that larger schools will have more disturbances, but subgroups in large schools will reduce these adverse effects. Methods . The hypotheses were tested by looking at the relation between disturbances and interscholastic sports programs in Montgomery County, Maryland high schools. Using three years of data on each high school in the county, the study regresses disturbances on sports participation, holding constant demographic variables, school size, and a dummy variable for each school. Results . Larger schools have more disturbances, but bigger interscholastic sports programs mitigate these effects. Conclusions . The policy implications suggest that to foster cooperative behavior in high schools, it might be wise to limit school size, or to foster participation in varsity sports as school size increases.     

Personal Identity and Civic Responsibility: "Rising to the Occasion" Narratives and Generativity in Community Action Student Interns

Twenty–two students in a community action certificate program supplied "rising to the occasion" narratives during summer–long internships. They also filled out measures of generativity. Twenty–one students in an international studies certificate program that also included a summer internship served as a comparison group. Both groups reported equal personal growth from rising to the occasion experiences and no differences on measures of optimism, self–esteem or generativity. However, the community action students linked their personal growth experiences to future community service; a regression analysis also revealed that the best predictor of their stress–related growth was their level of generative concern. No comparable links emerged for the comparison group. Implications for cultivating connections between personal identity and civic responsibility through service–learning are discussed.     

Peripubertal Girls' Romantic and Platonic Involvement With Boys: Associations With Body Image and Depression Symptoms

This study explored the relationship of both romantic and platonic involvement with boys, as well as pubertal status, to body image and depression symptoms among an ethnically diverse sample of sixth‐grade girls. Participants were 157 early adolescent girls (ages 10–13) who completed self‐report measures designed to assess girls' level of involvement with boys, pubertal status, and psychological adjustment. Girls' degree of romantic involvement was positively associated with higher depression scores. More advanced pubertal status was associated with both lower body image satisfaction and higher depression scores. A significant interaction between platonic involvement and pubertal status emerged. Girls who were less sexually mature but who also reported more platonic involvement with boys reported greater body image satisfaction. These findings suggest that the type of involvement with boys (romantic vs. platonic) and a girl's pubertal status influence psychological adjustment.     

Patterns of matching and initiation: Touch behavior and touch avoidance across romantic relationship stages

This study explores the similarity of touch behavior and touch attitudes among dating and married couples. Touch behavior showed a strong matching effect for seriously dating and married couples. Z-tests revealed that correlations between relational partners were significantly stronger for marrieds than for serious or casual daters. Results for attitudes concerning touch showed a statistically significant but weak relationship between dyadic partners though the correlation strengthened in closer relationships. As was the case in previous studies, results showed that women reported less positive attitudes toward opposite-sex touch than men. A linear contrast in proportions demonstrated that men initiated touch significantly more in casual romantic relationships, but women initiated touch more in married relationships. Together, these data suggest that patterns of matching may vary as a function of relationship stage, while patterns of touch initiation may vary as a function of both relationship stage and sex.She will be at Pennsylvania State University in the Fall.An earlier version of this paper was presented at the 1991 meeting of the Western States Communication Association, Phoenix, AZ. The authors thank Johanna Bailey, Brigitte Bellocq, Trish Brehault, Shaun Cantor, Ronan Collver, Vico Guerrero, Lisa Kaplan, Erika Nelson, and Dan Riley for assistance in data collection and entry.